Provider Demographics
NPI:1073175071
Name:GRAHAM, DENISE FLOYD (LPN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:FLOYD
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MAGNOLIA CIR
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-1501
Mailing Address - Country:US
Mailing Address - Phone:843-758-5127
Mailing Address - Fax:
Practice Address - Street 1:121 MAGNOLIA CIR
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-1501
Practice Address - Country:US
Practice Address - Phone:843-758-5127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPN.27231164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse